MEDICARE: AMY EVANS CRNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	5091259-4406	UT

General Provider Information

NPI Number	:	1417143827
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY EVANS CRNA

Provider Business Mailing Address
First Line	:	3070 LITTLE COTTONWOOD RD
Second Line	:
City	:	SANDY
State	:	UT
Zip	:	84092-3544
Country	:	US
Telephone Number	:	310-947-4923
Fax Number	:

Provider Business Practice Location Address
First Line	:	3070 LITTLE COTTONWOOD RD
Second Line	:
City	:	SANDY
State	:	UT
Zip	:	84092-3544
Country	:	US
Telephone Number	:	310-947-4923
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/19/2007
Last Update Date	:	09/26/2011

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